Questions for the Record, Legislative Hearing on H.R. 5549 (July 28, 2022)
Summary
Questions for the Record from Rep. Westerman for the Committee on Natural Resources, Subcommittee for Indigenous Peoples of the United States, legislative hearing on H.R. 5549, July 28, 2022. The questions are addressed to Elizabeth Fowler of the Indian Health Service, Alberta Unok of the Alaska Native Health Board, and Jarred-Michael Erickson of the Confederated Tribes of the Colville Reservation. They ask about implementing GAO recommendations and removing IHS from the GAO High-Risk List, tribal consultation in the IHS budget process, a PRC issue affecting Colville members, advance appropriations, and provider recruitment and retention. The text contains questions only; no answers are printed.
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“Questions for the Record, Legislative Hearing on H.R. 5549 (July 28, 2022).”
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COMMITTEE ON NATURAL RESOURCES
SUBCOMMITTEE FOR INDIGENOUS PEOPLES OF THE UNITED STATES
1324 LHOB & CISCO WEBEX
July 28, 2022 at 1:00 p.m. ET
Questions for the Record
Legislative Hearing on H.R. 5549
Questions from Rep. Westerman for Elizabeth Fowler, Indian Health Service
1. Please expand on your answer about implementing the GAO recommendations for the
IHS, and answer:
a. For the 4 recommendations you mentioned that remain open without requests to
close, please elaborate on the plan in place to implement and close those
recommendations.
b. When is the Action plan mentioned anticipated by IHS to be in place?
c. What are the 11 actions that IHS intends to accomplish with the goal of removing
IHS from the GAO’s High-Risk List?
d. Are there legislative actions Congress can take to speed up this process?
2. Please expand on how the IHS budget process works and how all tribes are involved in
meaningful consultation, and answer:
a. Please detail IHS's current tribal consultation process, and include timelines and
available lists of tribes that have consistently participated in the budget process.
b. What steps are in place to ensure meaningful tribal consultation happens,
particularly with tribes that may access a smaller amount of the IHS budget?
c. How is IHS ensuring that tribes involved with the IHS budget committee do not
have an outsized impact on budget formulation?
d. Are there any of the 11 actions mentioned as a part of the IHS and GAO Action
plan that implicate how IHS will do tribal consultation in the future?
3. Please expand on how IHS is determining if the PRC issue that has affected members of
the Confederated Tribes of the Colville Reservation, and answer:
a. What actions has IHS taken to determine what tribes are affected by this issue?
b. Has IHS received documentation from other direct service tribes about this issue,
and, if yes, what tribes have sent documentation and what was the documentation
and when was that documentation received?
COMMITTEE ON NATURAL RESOURCES
SUBCOMMITTEE FOR INDIGENOUS PEOPLES OF THE UNITED STATES
1324 LHOB & CISCO WEBEX
July 28, 2022 at 1:00 p.m. ET
Questions for the Record
4. Please expand on your answer about systems and oversight in place to receive advance
appropriations at IHS, and answer:
a. What specific process does IHS have in advance to identify estimates for accounts
that could receive advance appropriations?
b. Have those processes been used for current appropriations accounts and the
budgeting process, and if yes, have those estimates been correct in terms of the
actual monetary amounts needed for the accounts, or have the accounts been
underfunded because the actual monetary amounts were underestimated by IHS?
c. Has the IHS underestimated monetary amounts needed in any current
appropriations account? If yes, which account(s)? And what needs to be done for
IHS to not continue to underestimate those accounts?
5. Can you elaborate on why IHS changed their focus from advance appropriations in the
FY2022 budget request to recommending mandatory appropriations in the FY2023
request?
6. The IHS and the Veterans Administration both serve specific populations under assumed
federal responsibility and there is frequent overlap between the VA and IHS, because
many Native Americans have served in the armed forces and can receive care through
VA or IHS facilities.
a. Can you detail what effect, if any, VA advance appropriations has had an impact
on the cost sharing between VA and IHS?
Question from Rep. Westerman for Alberta Unok, Alaska Native Health Board
1. Question: Could you further elaborate on the unique aspects of health care in Alaska and
for Alaska Natives that are particularly vulnerable to uncertain appropriations?
COMMITTEE ON NATURAL RESOURCES
SUBCOMMITTEE FOR INDIGENOUS PEOPLES OF THE UNITED STATES
1324 LHOB & CISCO WEBEX
July 28, 2022 at 1:00 p.m. ET
Questions for the Record
Questions from Rep. Westerman for Jarred-Michael Erickson, Confederated Tribes of the
Colville Reservation
1. Question: Please further elaborate on your answer and document further stories about
instances of tribal members being referred to collection agencies because IHS did not pay
provider bills.
2. Question: Please further elaborate on the issues regarding recruitment and retention of
health providers.
a. How would advance appropriations prevent the kind of disruptions the Colville
Service Unit has experienced in trying to hire providers?
b. What ideas or thoughts do you have on how IHS can improve recruitment and
retention generally?
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